NPIMap

Organization Active NPI

Methodist Health, Inc.

Doing business as Deaconess Henderson Pediatrics Elm St

  • Pediatrics Physician
  • Henderson, KY
National Provider Identifier
1457784126
Registry record updated Nov 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
METHODIST HEALTH, INC.
Doing business as
Deaconess Henderson Pediatrics Elm St
Practice address
2000 N Elm St
Henderson, KY 42420-2385
Phone
(270) 827-3573
Fax
(270) 827-1250
NPI assigned
Aug 16, 2013
Last updated
Nov 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephanie Jenkins
Title
VP
Phone
(270) 827-7118

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary
Nurse Practitioner 363L00000X
Family Nurse Practitioner 363LF0000X
Pediatric Nurse Practitioner 363LP0200X

Addresses

Primary practice location

2000 N Elm St
Henderson, KY 42420-2385

Mailing address

PO Box 638706
Cincinnati, OH 45263-8706
Phone (270) 827-3573

Other identifiers 1

IdentifierTypeStateIssuer
7100279200MedicaidKY

Other names 1

  • Deaconess Henderson Pediatrics Elm St Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031204000875 KY Part B Supplier - Clinic/Group Practice 4981508454 Receives reassigned benefits from 127 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Morganfield, KY; Henderson, KY; Dixon, KY

Other NPIs on the same Medicare enrollment 24

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 24

National Provider Directory

National Provider Directory

Locations

1971 Barrett CT Ste B
Henderson, KY 42420

2000 N Elm St
Ste 1B4
Henderson, KY 42420

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1457784126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 638706",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452638706",
            "telephone_number": "270-827-3573",
            "fax_number": "270-827-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N ELM ST",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202385",
            "telephone_number": "270-827-3573",
            "fax_number": "270-827-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METHODIST HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-16",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "270-827-7118"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100279200",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess Henderson Pediatrics Elm St",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.